The “7 Deadly Sins” That Lead to Preventable Readmissions

Preventable readmissions are a top focus for healthcare administration due to recent Medicare penalties.

Preventable readmissions are a top focus for healthcare administration due to recent Medicare penalties. Starting October 1, the CMS Readmissions Reduction Program will increase the maximum penalty to 3% and add COPD and total hip and knee replacements to the list of measures. New payment structures like bundled payments add more pressure by offering no reimbursement for costs outside of the original episode.

The Robert Wood Johnson Foundation released a 2013 report showing that one in eight Medicare patients were readmitted to the hospital within 30 days of being released after surgery in 2010, while patients in the hospital for reasons other than surgery returned at an even higher rate of one in six.

The readmission rates for joint replacement are traditionally low compared to other procedures, but soon a few readmissions could cost your program dearly as the industry moves to pay for performance and bundled payments contracts. If reducing readmissions is one of your goals, here are 7 deadly sins that must be avoided to ensure that once patients leave your facility they don’t return too soon:

1. Poor Discharge Planning and Patient Education The AHRQ found that patients who have a clear understanding of their after-hospital care instructions are 30 percent less likely to be readmitted or visit the ER than patients who lack this information. A variety of teaching tools and approaches can be used early and often to reinforce important information. For a planned surgery like joint replacement, proactive education and discharge planning can start as soon as the patient is scheduled for surgery.

2. Absent post-acute care partnerships A poor performing SNF can be the downfall of your hospital’s readmission rate. Be sure to set up relationships with post-acute care providers and make your expectations known. Metrics of their performance should be tracked and SNFs who aren’t up to snuff should be removed from your “preferred” network. Communication during the hospital to PCP/surgeon handoff is also key to make sure patients schedule and attend their follow-up appointments.

3. Staying Silent After Discharge With these new policies, after a patient leaves the hospital, they can still be your responsibility for up to 180 days. Every patient needs a follow-up plan and should have some sequence of post-discharge outreach: nurse calls, triggered emails, home visits, PCP appointments, etc. High-risk patients can have more intensive plans, while healthy patients can have automated calls or email check-ins. Staying in touch with patients after they leave also lets them know you care and can improve satisfaction scores.

4. Ignoring the Family or Caregiver A patient’s family member or caregiver can be your most powerful ally. Be sure to bring them in often and early and make sure they are ready to support their patient at home. Conversely, if there is a lack of family support or the patient will be returning home alone, this is a warning sign that can be used to set up extra support.

5. Walking Ahead Blindly Are you tracking your metrics? Service lines should be able to track the number of cases that readmit within 30-, 60-, 90- and 180-day frequencies, and how their floor or unit readmission rates compare to the overall hospital. Tracking readmission interventions performed by nurse navigators or care coordinators can also show effectiveness for these roles and justify staffing.

6. Treating All Patients the Same Patients with co-morbidities need to be treated differently than healthy patients presenting for surgery. Patients should be risk-stratified and have plans tailored to their needs according to age, education level, medications, readiness, number of recent hospitalizations and other relevant factors.

7. Poor Triage Practices Make sure patients know who they should turn to with questions or concerns after they leave. When a knee incision is red with drainage, is it normal or is it infected? Giving patients the tools to make the right follow-up contact (surgeon’s office next day or ER right now?) will be key to avoid unnecessary return trips to the hospital.

Let me know in the comments, what strategies are you using to prevent readmissions?